García Olmos L, Abraira V, Gervas J, Otero A, Pérez Fernández M
Centro de Salud La Chopera, Alcobendas, Madrid, Spain.
Fam Pract. 1995 Jun;12(2):159-62. doi: 10.1093/fampra/12.2.159.
The purpose of this study is to explore the causes that may influence the variations on referral rates in a sample of 242 general practitioners (GPs) in Spain. We applied Poisson multivariant regression modeling to analyze the role played by different variables related to doctors, patients and practices. The mean referral rate was 6.92 +/- 0.22 with a variant coefficient of 50.6%. The results of the Poisson model showed a statistically significant variation on the following variables: 1) doctor gender; 2) proportion of consultations to the practice made by male patients; 3) proportion of consultations made by patients over 65 years of age; 4) list size, 5) number of doctors in the PCT; 6) number of practice consultations to each doctor per week; 7) accredited practice for VT; 8) location of practice; 9) proportion of outpatient referrals; 10) proportion of private referrals; 11) proportion of emergency referrals; 12) proportion of referrals in which the patient's attitude did not influence the doctor for the referral; 13) proportion of new referrals. The statistical significance for the final model was very high (P < 0.00001). The study draws attention to the influence of some structural characteristics of health care system on the referral rates that could be modified to reduce the number of referrals from Primary to Secondary Care.
本研究旨在探究西班牙242名全科医生样本中可能影响转诊率变化的原因。我们应用泊松多元回归模型来分析与医生、患者及医疗实践相关的不同变量所起的作用。平均转诊率为6.92±0.22，变异系数为50.6%。泊松模型的结果显示，以下变量存在统计学上的显著差异：1) 医生性别；2) 男性患者在该医疗实践中的就诊比例；3) 65岁以上患者的就诊比例；4) 患者名单规模；5) 初级保健信托基金中的医生数量；6) 每位医生每周的门诊就诊次数；7) 获得职业培训认证的医疗实践；8) 医疗实践地点；9) 门诊转诊比例；10) 私人转诊比例；11) 急诊转诊比例；12) 患者态度不影响医生转诊的转诊比例；13) 新转诊比例。最终模型的统计学显著性非常高（P<0.00001）。该研究提请人们注意医疗保健系统的一些结构特征对转诊率的影响，这些影响可以通过调整来减少从初级保健向二级保健的转诊数量。
